What insurance risks are included in the CASCO agreement?

Insured event under compulsory motor liability insurance:

An insured event is the occurrence of civil liability of the owner of a vehicle for causing harm to the life, health or property of victims when using the vehicle, entailing, in accordance with the compulsory insurance contract, the insurer’s obligation to provide insurance compensation;... (Article 1 of the Federal Law of April 25, 2002 N 40 -FZ “On compulsory civil liability insurance of vehicle owners” as amended by Federal Laws dated December 1, 2007 N 306-FZ, dated March 28, 2017 N 49-FZ)

Based on the above definition of the concept of “insured event”, the onset of civil liability of the owner of the vehicle is possible only when using the vehicle. Explanations on what is meant by “use of a vehicle” are given in paragraph 12 of the Resolution of the Plenum of the Supreme Court of the Russian Federation dated December 26, 2017 N 58 “On the application by courts of legislation on compulsory civil liability insurance of vehicle owners”:

“..The use of a vehicle should be understood not only as mechanical (physical) movement in space, but also all actions associated with this movement and other operation of the vehicle as a source of increased danger.
In relation to the Law on Compulsory Motor Liability Insurance, the use of a vehicle means its operation within the boundaries of roads, as well as in areas adjacent to roads and intended for the movement of vehicles (in courtyards, in residential areas, in vehicle parking lots, gas stations, as well as any other territories , on which it is possible to move (pass) a vehicle).
Harm caused by the operation of equipment installed on a vehicle and not directly related to the participation of the vehicle in road traffic (for example, a slewing bearing of a truck crane, a concrete mixer, unloading mechanisms, a manipulator boom, an advertising structure on a car) does not apply to cases of harm. the vehicle itself (paragraph two of Article 1 of the Law on Compulsory Motor Liability Insurance).”

What cases are not covered by insurance?

Insurance companies will not cover treatment costs if you are injured as a result of:

alcohol or drug intoxication;
driving a vehicle without a license;
transferring control of a vehicle to a person without a license;
traveling in a vehicle driven by a drunk driver;
participation in criminal activities, demonstrations and strikes;
military actions or terrorist attacks;
natural Disasters.

Also, treatment that is not agreed upon with the insurance company (except for emergency medical care) or is not documented is not considered an insured event.

Insured event under a civil liability insurance contract during construction:

An insured event under a civil liability insurance contract is the onset of civil liability of persons whose liability is insured for obligations arising from damage caused as a result of deficiencies in the construction work specified in the insurance contract, which affect the safety of capital construction projects;... (“Guidelines for civil insurance responsibility of members of self-regulatory organizations based on the membership of persons carrying out construction"; approved at a meeting of the Ministry of Regional Development of the Russian Federation, minutes of 02.27.2010)

Documents for registration of an insured event

Consideration of the issue of recognizing a situation as an insured event begins when the company receives a complete package of documents. These include:

a personal statement from the policyholder, which fully describes the circumstances of the case;
list of stolen, lost, damaged property;
an act confirming the fact of destruction of property.

This document is drawn up taking into account all current insurance rules and must contain a detailed description of the situation in which the event occurred, indicating the reasons, conditions and other details of what happened.

Such an act is a necessary basis for establishing the right to payment for an insured event, calculating the amount of damage, and determining the amount of compensation. That is why it must be drawn up in as much detail as possible so that the company employee has a complete picture of the event.

Insured event under insurance in case of temporary disability and in connection with maternity:

An insured event under compulsory social insurance in case of temporary disability and in connection with maternity is an accomplished event, upon the occurrence of which the insurer becomes obligated, and in some cases established by this Federal Law, the insured, to provide insurance coverage;... (clause 2 of part 1 of article 1.2 Federal Law of December 29, 2006 N 255-FZ “On compulsory social insurance in case of temporary disability and in connection with maternity”)

What diseases can you insure against?

Dear readers!

Our articles talk about typical ways to resolve legal issues, but each case is unique. If you want to find out how to solve your particular problem, please contact the online consultant form

It's fast and free!

Or call us by phone (24/7):

If you want to find out how to solve your particular problem, call us by phone. It's fast and free!

What else to read:

Basic compulsory health insurance program
Cancer insurance: what is it, how does it work, how much does it cost?
What is VHI in medicine: in simple words about the complex

+7 (495) 980-97-90(ext.589) Moscow,

Moscow region

+8 (812) 449-45-96(ext.928) St. Petersburg,

Leningrad region

+8 (800) 700-99-56 (ext. 590) Regions
(free call for all regions of Russia)
Health insurance includes a list of various diseases. It differs depending on the company with which the person took out the policy.

The standard list of diseases included in the insurance looks like this:

heart attack;
stroke;
sexually transmitted diseases – HIV, AIDS;
renal failure;
paralysis;
cancerous tumors;
loss of vision or hearing, etc.

If the insurance owner is afraid of certain diseases, he may have to pay extra to include them in the insurance. The larger the list of diseases that the policy covers, the higher its cost.

It should be immediately noted that the policy does not allow reimbursement of costs associated with chronic diseases, diabetes, as well as heart attack and stroke, if all these conditions arose before the policy was issued. Insurance companies refuse to provide insurance to persons with these disorders, because it is unprofitable for them. If the fact of the presence of a disease is discovered after signing the contract (provided that the person deliberately concealed this fact), the insurance can be appealed, and its owner can be recognized as a fraudster.

Insured event under compulsory social insurance:

An insured event is a fact of damage to the health of the insured person confirmed in the established manner as a result of an industrial accident or occupational disease, which entails the insurer’s obligation to provide insurance coverage;... (paragraph 9 of Article 3 of the Federal Law of July 24, 1998 N 125-FZ “On Mandatory social insurance against accidents at work and occupational diseases")

An insured event is an accomplished event, upon the occurrence of which the insurer becomes obligated, and in some cases established by federal laws, also the insured, to provide coverage for compulsory social insurance;... (Article 3 of the Federal Law of July 16, 1999 N 165-FZ “On the Fundamentals compulsory social insurance")

What risks does this type of insurance cover?

The object of insurance is property interests. The policyholder independently chooses which conditions the policy covers: industrial or household. The tariff depends on the profession and its characteristic hazards, the insurance period and the set of risks. The latter include:

temporary disability, injury/mutilation due to an accident
hospitalization and surgery for the same reason
disability - complete loss of ability to work
death other than suicide

Insured event during deposit insurance:

..An insured event is one of the following circumstances:

revocation (cancellation) of a bank’s license from the Bank of Russia to carry out banking operations (hereinafter referred to as the Bank of Russia license) in accordance with the Federal Law “On Banks and Banking Activities”, if the Agency’s participation plan in settling the bank’s obligations in accordance with the Federal Law dated 26 is not implemented October 2002 N 127-FZ “On Insolvency (Bankruptcy)” (hereinafter referred to as the Federal Law “On Insolvency (Bankruptcy)";
introduction by the Bank of Russia, in accordance with the legislation of the Russian Federation, of a moratorium on satisfying the claims of bank creditors... (clause 1 of Article 8 of the Federal Law of December 23, 2003 N 177-FZ “On insurance of deposits of individuals in banks of the Russian Federation”)

How to get compensation from an insurance company?

If the insurance company cannot pay for the treatment directly, but offers to reimburse the costs, you need to proceed as follows. Coordinate all your actions with a representative of the insurance company, keep all invoices and receipts. When you return home, you will need to provide:

application for compensation;
insurance policy;
medical bills and receipts;
receipts for purchased medications;
receipts for taxi trips to the clinic;
printout of data on calls to the insurance company.

A detailed list of required documents is contained in the Insurance Rules.

Insured event under the contract of compulsory liability insurance of the arbitration manager:

“An insured event under a contract of compulsory insurance of the liability of an arbitration manager is the onset of liability of the arbitration manager to persons participating in the bankruptcy case or other persons in connection with the non-fulfillment or improper performance by the arbitration manager of the duties assigned to him in the bankruptcy case, confirmed by a court decision that has entered into legal force, except for the cases provided for in paragraph 6 of this article...” (clause 5 of Article 24.1 of the Bankruptcy Law)

Health insurance programs

When registering, you can choose different insurance programs. There are insurance policies aimed at a specific group of diseases. For example, the AlfaStrakhovanie product called AntiONKO allows you to be treated in foreign clinics for up to 6 million rubles (the tariff includes flights and accommodation) in the event of a cancerous tumor.

The VTB Insurance program called “Online Tick Protection” allows you to receive compensation from 400 thousand rubles in case of a tick bite. The policy can include several people at once, which is convenient for a family or group of friends.

In addition to ready-made programs, the client can choose for himself which diseases to insure against. True, an individual set of options will cost more.

Explanations of the Supreme Court of the Russian Federation on the insured event

Clause 12 of the Resolution of the Plenum of the Supreme Court of the Russian Federation dated June 27, 2013 N 20 “On the application by courts of legislation on voluntary insurance of citizens’ property” contains the following explanations:

In accordance with paragraph 2 of Article 9 of the Law on the Organization of Insurance Business, an insured event is understood as an event that has occurred, provided for in a voluntary property insurance agreement, upon the occurrence of which the insurer becomes obligated to pay insurance compensation to the person in whose favor the insurance agreement is concluded (the policyholder, the beneficiary).

An insured event includes the danger against which insurance is provided, the fact of causing harm and the causal relationship between the danger and harm and is considered to have occurred from the moment of causing harm (loss, death, identification of shortage or damage to the insured property) as a result of the danger for which insurance was carried out . If damage is detected outside the term of the contract, the person in whose favor the insurance contract is concluded (the policyholder, the beneficiary) has the right to an insurance payment if the damage was caused or began to be caused during the period of the contract. If, based on the circumstances of the case, the moment of causing harm cannot be reliably determined, the harm is considered to have been caused at the time of its detection.

If the danger for which insurance was provided arose during the period of validity of the contract, and the damage began to occur outside the period of its validity, the insured event is not considered to have occurred and the insurer is not liable to pay insurance compensation.

The alleged event, in the event of which insurance is carried out, must have signs of probability and chance. In this case, an event is considered accidental if, at the conclusion of the insurance contract, the parties to the contract did not know and should not have known about its occurrence or that it could not occur.

Author of the publication

offline 12 hours

What is considered an accident?

For an incident to fall under this concept, an effect of surprise is needed. If a person could have prevented the trouble, for example, burns occurred after being under the scorching sun on the beach, payment will be denied. Compensation is also not provided if the insured person intentionally caused physical harm to himself, committed illegal actions, or was under the influence of alcohol/drugs/toxic drugs. You should not call the insurance company during exacerbations of chronic diseases.

Accidents also include unintentional poisoning, with the exception of toxicological infections, sudden illness with polio and tick-borne encephalitis, removal of organs as a result of erroneous medical procedures, anaphylactic shock, and drowning. Some insurance companies include in the list of risks the initial diagnosis of critically dangerous diseases: cancer, myocardial infarction, stroke.

Insurance companies have different requirements for applicants: in one - his age cannot exceed 70 years, and in the other - 60 years

Procedure for investigating insurance claims

The process of investigating insured events and preparing the necessary documents is regulated by Art. Art. 227 - 230 of the Labor Code of the Russian Federation, Resolution of the Ministry of Labor of Russia dated October 24, 2002 No. 73 “On approval of the forms of documents necessary for the investigation and recording of industrial accidents, and provisions on the features of the investigation of industrial accidents in certain industries and organizations” (hereinafter referred to in the text also - Resolution No. 73), Decree of the Government of the Russian Federation of December 15, 2000 No. 967 “On approval of the Regulations on the investigation and recording of occupational diseases” (hereinafter also referred to as Resolution No. 967). The list of occupational diseases (list of professions) is approved in the Appendix to the order of the Ministry of Health and Social Development of the Russian Federation dated April 27, 2012 No. 417n (hereinafter also referred to as List No. 417n).

Some clarifications are also contained in the Letter of Rostrud dated April 10, 2020 No. 550-PR “On classifying cases of infection of medical workers with coronavirus infection as occupational diseases” (hereinafter also referred to as Letter No. 550-PR). In this letter, due to the presence of cases of infection of medical workers with coronavirus infection while performing their official duties, the Federal Service for Labor and Employment reports the following:

Damage to the health of workers as a result of exposure to harmful or dangerous factors present in the workplace may be regarded as an occupational injury or occupational disease, depending on the damaging factor.

To biological harmful factors in accordance with “R 2.2.2006-05. 2.2. Occupational hygiene. Guidelines for hygienic assessment of working environment and labor process factors. Criteria and classification of working conditions" (approved by the Chief State Sanitary Doctor of the Russian Federation on July 29, 2005) include producing microorganisms, living cells and spores contained in bacterial preparations, pathogenic microorganisms (bacteria, viruses, rickettsia, fungi) - causative agents of infectious diseases.

According to Art. 3 of Law No. 125-FZ, occupational disease is a chronic or acute disease of the insured, resulting from exposure to a harmful production factor(s) and resulting in temporary or permanent loss of professional ability and (or) death.

Also, the concepts of acute occupational disease and chronic occupational disease are specified in paragraph 4 of the Regulations on the investigation and recording of occupational diseases, approved by Resolution No. 967.

In accordance with clause 3.1 of List No. 417n, occupational diseases are infectious and parasitic diseases associated with exposure to infectious agents, including coronavirus infection. At the same time, workers are exposed to a harmful production factor - pathogens of infectious and parasitic diseases with which workers are in contact during work.

The group of occupational diseases of medical workers includes infectious and parasitic diseases that are similar to the infection with which workers come into contact during work: tuberculosis, toxoplasmosis, viral hepatitis, skin mycoses, syphilis, HIV infection.

In addition, issues of occupational diseases of medical workers and their investigation are reflected in the Methodological Recommendations approved by the Chief State Sanitary Doctor of the Russian Federation on August 16, 2007 (“MR 2.2.9.2242-07. 2.2.9. Health status of workers in connection with the state of the working environment. Hygienic and epidemiological requirements for working conditions of medical workers performing work associated with the risk of infectious diseases. Methodological recommendations").

Regarding the investigation of cases of infection of medical workers with coronavirus infection as accidents subject to investigation in accordance with the requirements of Art. Art. 227 - 230.1 of the Labor Code of the Russian Federation, in addition to the above, it is necessary to take into account the requirements of Resolution No. 73.

Paragraph 7 of Resolution No. 73 establishes that acute occupational diseases (poisonings), in respect of which there is reason to believe that their occurrence is due to exposure to harmful production factors, are subject to investigation in accordance with Resolution No. 967 (with the exception of cases when an infection enters the worker’s body due to mechanical damage to the integrity of the skin).

Thus, cases of infection of medical workers with coronavirus infection during the performance of their work duties are subject to investigation in accordance with the requirements of Resolution No. 967 by Rospotrebnadzor bodies as occupational diseases with the execution of the corresponding act on the case of occupational disease and sending a copy of the act with investigation materials to the territorial body of the Federal Social Insurance Fund of the Russian Federation.

In relation to the indicated conclusion of Letter No. 550-PR, a reservation should be made in relation to those very outsourced ambulance drivers discussed in the article “Insurance of medical workers against accidents and occupational diseases: general provisions.” Since they are not employees of a medical organization, they are not subject to the provisions of List No. 417n. Simply put, formally, contracting coronavirus infections by such drivers will not be considered an occupational disease. Consequently, through the mechanism for investigating occupational diseases provided for by Resolution No. 967, these persons will not be able to confirm the existence of an insured event. However, in this case, it seems justified to follow the investigation scheme for industrial accidents regulated by Resolution No. 73, including in relation to the investigation of those in relation to workers that occurred at another employer. This possibility is expressly provided for: Part 5 of Art. 229 of the Labor Code of the Russian Federation, which provides that “an accident that occurs with a person sent to perform work for another employer and participating in his production activities is investigated by a commission formed by the employer who experienced the accident”; “the commission includes a representative of the employer who sent this person,” as well as the norms of part 1, paragraph 10 of Resolution No. 73.

It would also not be superfluous to add that, according to Art. 1072 of the Civil Code of the Russian Federation, with reference to paragraph 1 of Art. 935 of the Civil Code of the Russian Federation, a legal entity or a citizen who has insured its liability through voluntary or compulsory insurance in favor of the victim in the case where the insurance compensation is not enough to fully compensate for the harm caused, compensate the difference between the insurance compensation and the actual amount of damage. Thus, injured employees of medical and other organizations also have the right to assert in court the right to subsidiary insurance compensation from their employers in the event of insufficient funds for the insurance compensation determined by them in accordance with Law No. 125-FZ and paid by the Federal Social Insurance Fund of the Russian Federation.

Also, from the meaning of Letter No. 550-PR, it follows that if, during the investigation of a medical worker’s infection with COVID-19, a Rospotrebnadzor specialist identifies facts of violation of labor protection requirements and (or) concealment of an insured event that caused the disease, the employer and (or) his responsible person For this, employees most likely cannot avoid administrative liability provided for in Part 1.2 of Art. 5.27., part 1, 4 tbsp. 5.27.1., Art. 15.34 of the Code of Administrative Offenses of the Russian Federation (in the most severe cases, it is possible to bring the perpetrators to criminal liability in accordance with Article 143 of the Criminal Code of the Russian Federation, however, in the midst of the COVID-19 pandemic, its use seems unlikely). Basically these are penalties. However, here again lies another “BUT”: let’s say, part 4 of Art. 5.27.1. The Administrative Code of the Russian Federation, which provides for administrative liability for failure to provide workers with PPE (while everyone knows that in the current situation, medical organizations are not properly provided with such equipment in principle due to their banal physical shortage), seems to be another “distortion”.

However, based on the requirements of Part 4 of Art. 230 of the Labor Code of the Russian Federation, standard forms of documents documenting the results of such investigations, approved by Resolution No. 73 and Resolution No. 967, as well as the established practice of our control and supervisory authorities, facts of violation of labor protection requirements and (or) concealment of insured events in any case by Rospotrebnadzor specialists will be identified, the perpetrators will definitely be identified, be it officials from among the administration, senior, junior medical staff and (or) the injured employee himself, and organizational conclusions will be drawn.

Therefore, no matter what, the “extreme” ones will still have to be “appointed”. Moreover, for the injured employee himself, the conclusion that he is guilty of what happened to him in the form of gross negligence can result not only in bringing him to administrative responsibility, but also in reducing to 25% the amount of monthly payments as one of the types of social security provided for by Law No. 125-FZ ( Art. 14). Whether the factor of guilt of the injured employee will be taken into account when adjusting the amount of payments provided for by the Decree will most likely be demonstrated by the law enforcement practice of the judiciary.

The next stage, as applied to persons who have acquired permanent loss of professional ability to work (that is, disability) as a result of an accident/occupational disease, is a medical and social examination.